Forms -  

We designed these documents to better assist both the school districts and the Medicaid Reimbursement Office in obtaining all of the necessary information for Medicaid claiming.  We hope that school districts will find these forms useful.  Fee free to add your schools' name, address and contact information to these forms.  

Physician Orders for Physical Therapy, Occupational Therapy, medications and medical treatment for students receiving school-based services:

    Word Document Physician Prescription

    Word Document Medication Administration

    Word Document Authorization for Medical Treatment 

“Under the Direction of”  and "Supervision of "Documentation for Medicaid Billable Services by Limited Licensed Staff:

   Word DocumentPhysical Therapist Assistant 

 

   Word DocumentPsychologist  

 

   Word DocumentSocial Worker

   Word DocumentSpeech Language Pathologist